If you have stress incontinence, one of the two most common types of incontinence, midurethral sling surgery can offer an effective option.
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Women with stress incontinence can experience urine leakage because of any increase in intra-abdominal pressure, including a cough, laugh, or sneeze, says Matthew Barber, MD, urogynecologist. If this happens a lot, it makes sense to consider the surgery, he says.
“Urinary incontinence is a quality-of-life disorder,” he says. “Surgery needs to happen at a time when the problem is bothering a woman enough to prevent her from doing things she wants to do.”
A weak urethra that can’t withstand normal pressures leads to stress incontinence. If you can lose weight, this can help lessen it considerably. You can also do pelvic floor muscle exercises to strengthen the pelvic floor, Dr. Barber says.
But failing those solutions, doctors usually recommend what’s called a midurethral sling. This small piece of mesh material goes under the middle portion of the urethra and “provides a backstop,” Dr. Barber says. “It’s tension-free, so it doesn’t press against the urethra, just buttresses it when one bears down.”
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Why sling surgery
Among the benefits, slings are as effective, or more effective, than the traditional operations. Also, complication rates are lower.
Additionally, the other surgical options to treat stress incontinence are more likely to cause incontinence of a different sort. Known as urge incontinence, this amounts to “a very strong desire to empty the bladder,” Dr. Barber says.
Sling surgery traditionally is not offered to treat the problem of urge incontinence, which is the other common type of female incontinence.
A kind of breakdown in communication between the brain and bladder can cause urge incontinence rather than any anatomical weakness, Dr. Barber says. In this case, the bladder often contracts before the brain gives it permission to do so. “With this kind of incontinence, you have very little time. It’s that ‘gotta go, gotta go’ feeling. The end result is often leakage,” he says.
Treatment for urge incontinence can include:
- Exercises to strengthen muscles and reduce urge symptoms
- Botulinum toxin injections into the bladder
- Implanting a small electrode near the nerves involved to help modulate the nervous system activity.
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A national trial sponsored by the National Institute of Health (NIH) is underway to examine the use of the sling in women who have both stress and urge incontinence.
It’s called the ESTEEM trial (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence) and will be the largest of its kind to examine women who have this mixed incontinence condition, for whom long-term outcomes are unknown.
The study, which will be conducted in connection with the Pelvic Floor Disorders Network, is open to patients and Dr. Barber is one of the participating physicians.